Tongue Lip Adhesion in the Treatment of Robin Sequence: Respiratory, Feeding, and Surgical Outcomes

Abstract

Objective: Objective evaluation of the efficacy of tongue lip adhesion (TLA) in the management of Robin sequence (RS). Study Design: Retrospective cohort study. Setting: Tertiary referral hospital. Patients, Participants: The craniofacial database of Amsterdam UMC, Vrije Universiteit Amsterdam was searched to identify infants with RS who underwent tong lip adhesion (TLA). Forty-one RS infants who underwent TLA from 1993 to 2016 were identified. Interventions: TLA. Main Outcome Measure: The outcome measures were pre- and postoperative polysomnography results, nutritional status, weight gain, age at operation, hospital stay length, extubation time after TLA, and complications. Results: Forty-one RS patients were included who had TLA at an average age of 26.6 days. In 16 cases a pre- and postoperative polysomnography was performed. In 13 of these cases (81.3%) improvement was observed, in 2 (12.5%) the results were inconclusive, and in 1 (6.3%) no improvement was seen. Patients were extubated after a mean of 2.2 days. The mean hospital stay was 40.2 days. Reintervention was needed in 7 patients because of a wound dehiscence. The mean age of TLA release was 9.7 months. At discharge, 9 (22%) children still needed total nutritional support for persistent feeding difficulties. The average growth from birth to adhesion release was 4.6 kg. Conclusion: This cohort demonstrates that TLA is a successful procedure in children with RS in terms of respiratory, feeding, and growth outcome. Only minor complications were seen in our cohort.

Mandibular Distraction Osteogenesis in Robin Sequence Using Three-Dimensional Analysis and Planning

“…[5][6][7] The optimal surgical management of patients with Robin sequence remains a debate, but options include mandibular distraction osteogenesis, tongue-lip adhesion, and tracheostomy and feeding tube placement. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] The goal of mandibular distraction osteogenesis in these patients is to relieve airway obstruction from the tongue base, facilitate oral intake, and improve patient appearance while circumventing the need for tracheostomy. [23][24][25][26] The purpose of the accompanying video is to highlight the use by the senior author (D.M.S.)…”

“…5–7 The optimal surgical management of patients with Robin sequence remains a debate, but options include mandibular distraction osteogenesis, tongue-lip adhesion, and tracheostomy and feeding tube placement. 8–26…”

New perspectives in the treatment of patients with Robin Sequence

“…mandibular distraction (MDO) or tongue-lip-adhesion (TLA) could be performed. In our center if there is evidence of UAO that is not successfully managed by positioning alone or by positioning and nasogastric feeding, a TLA is performed Mermans et al, 2018).…”

“…This can be interpreted in two ways: the severity of UAO on itself does not correlate with long-term speech outcomes or the effect of the surgical procedure TLA does not affect long-term velopharyngeal function. However, the indication to perform a TLA was not purely based on objective PSG data in all patients but on clinical assessment as well (Mermans et al, 2018). Sometimes in severe clinical cases, a TLA was performed after the patient needed to be intubated because of severe UAO.…”

“…A retrospective chart review was performed of all consecutive patients with RS that underwent a Von Langenbeck repair with intravelar veloplasty between 1993 and 2014 at our centre and compared to patients with ICP. RS was defined as micrognathia, glossoptosis and UAO Mermans et al, 2018).…”